Provider Demographics
NPI:1265715403
Name:BENTLEY, MELINDA ELAINE (BS, RDH, LAP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ELAINE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:BS, RDH, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2888 SE TRIANGLE OUTFIT DR
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2551
Mailing Address - Country:US
Mailing Address - Phone:541-233-7122
Mailing Address - Fax:
Practice Address - Street 1:257 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1910
Practice Address - Country:US
Practice Address - Phone:541-447-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4534124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist